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General NPI Number Information
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NPI Number | 1376379347
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Entity Type | Individual
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Provider Name | RENZO RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 600 SANDTREE DR STE 202C
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1538
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Country | US
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Telephone | 561-203-1655
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N # 24027
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 561-203-1655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11035159
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License Number State | FL
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